Debates of April 27th, 1995

The House resumed consideration of the motion.

Supply

[Bernard Patry, Liberal, Pierrefonds—Dollard, QC]

Mr. Speaker, in 1984 the members of this House unanimously adopted the Canada Health Act. It was a particularly noteworthy event for two specific reasons. This legislation guaranteed quality health services to all Canadians, regardless of their income or their place of residence.

Furthermore, this piece of legislation was adopted unanimously by the members of all the parties. Everyone felt a national health insurance scheme was invaluable.

This government's commitment to universal health care remains unshaken. The Canada Health Act and the system we have built under its framework is a defining feature for our society. The essence of medicare is not to be found in the mysteries of a funding formula. It is certainly not to be found simply in the amount of money we spend. Rather, it is to be found in providing quality health care equally to all Canadians.

The five main principles underlying the Canada Health Act are: universality, accessibility, comprehensiveness, portability and public administration. They are rooted in values of fairness, social justice, compassion and respect for human dignity. These values are shared by all Canadians. They are part of our social fabric.

Some claim that our health insurance system is too costly and that we can no longer afford the luxury of a government funded system. On the contrary, I believe that our health insurance system is no luxury but a necessity and that public financing of this system helps keep health care costs under control.

In investing in health in general and in health care services, our government is helping to keep Canadians healthy and fit. They will be able to meet the economic challenges of the 21st century. Studies indicate that many days of work are lost to illness or accident. They all reach the same conclusion: these days lost have a negative effect on workers, society and the economy.

A health care system that Canadians can access without fear of financial hardship encourages people to seek medically necessary treatment before an illness or injury becomes life threatening or debilitating. Early diagnosis and treatment are far less expensive than chronic care, both to the individual and to the system. Such a system does not encourage patients to seek inappropriate care.

For those who think in terms of the bottom line, the principles of the Canada Health Act support an economically efficient health care system. These are economies of scale obtained from governments being the only buyers of medically necessary hospital and physician health care services and of the entire population being the customer base. A system that is publicly administered saves this country billions of dollars annually in administrative overhead. In hospitals and in clinics this frees up the resources in time to practise medicine, not administration.

Finally, medicare produces a healthy population, which in turn means a healthy and productive labour force. This is a reciprocal relationship between business and the health sector. A healthy business sector means economic growth. Economic growth means jobs. Jobs reduce unemployment, and less unemployment means a healthier population and reduced health costs. In other words, a healthy Canada is a wealthy Canada.

The fact that the Canada Health Act is both to flexible and too rigid was also deplored. Yet, according to the Canadian constitution, it is up to the provinces and territories to provide and administer health care services. Consequently, the provinces and territories must identify their own priorities and manage their resources.

Under the act, the provinces and territories must provide the required medical and hospital services. However, nothing prevents them from providing other types of services. This means that a province may pay for the costs of prescription drugs or dental care for children, while another may finance air ambulance services.

As long as it abides by the five basic principles underlying the Canada Health Act, each provincial or territorial government is free to provide additional services at its own cost, or experiment with different structures. The basic criteria governing federal financing under the Canada Health Act are the five principles previously mentioned. The government is not prepared to compromise on these principles.

The basic criteria for federal funding under the Canada Health Act are the five principles mentioned earlier. It is these that the government is not willing to negotiate.

The first principle is universality, meaning that all residents of a province must be insured under the provincial health plan if it is to receive federal support. We as Canadians believe we must all have access to medically necessary services. People cannot be deinsured because they might be costly for the system to cover. They cannot be turned away at the hospital door because, for example, they have not paid their quarterly tax bill or even their provincial premium. Any one of us needing health care will be treated the same as everyone else. This is what is meant by equity.

Accessibility on uniform terms and conditions is the second principle. We should not face any financial barriers in receiving health care, no extra billing, no user charges, no facility fees, no upfront cash payments. If the service is medically necessary, we

will get it at the time defined by medical consideration and not by money.

The principle of comprehensiveness is a recognition that Canadians have a number of needs which must be met. It would be unfair to insure only certain medical services. We will continue to contend that the provinces and territories must insure all medically necessary services.

However, comprehensiveness does not mean uniformity. It does not mean that the provinces and territories must all meet health care needs in exactly the same fashion. These needs must be met, but there is some flexibility as to how this can be achieved.

Portability means that Canadians are always covered by medicare when they travel or move within Canada. This is what gives our health care system its national dimension.

Canadians enjoy the freedom to work and travel anywhere in the country, without fear of losing their health insurance coverage. Each separate health insurance plan may be provincial in origin but is recognized nationally in every province across the country.

The fifth and final principle is public administration. Our health insurance plans must be operated by provincial governments on a non-profit basis. It is at the core of our ability to contain costs in a system and thus to deliver quality care at an affordable price.

Public administration is the key to ensuring all the other principles. When health insurance is operated and funded by the government, we can guarantee that health care is universal, accessible, comprehensive and portable because we have direct control over it. Public administration not only ensures that more of our health care dollars go toward patient care but it also makes governments more successful than the private sector in keeping health care costs under control.

In 1993 we spent about $72 billion on health care. This represents 10 per cent of our gross domestic product. The public component of that 10 per cent has been growing at less than 2 per cent. Compare that to private health spending which has been growing at 6.4 per cent.

However, complying with the provisions of the Canada Health Act does not prevent the provinces and territories from adopting innovative strategies to meet the challenges in providing health care services.

For example, British Columbia has set up emergency response teams, New Brunswick has established an extramural hospital and Quebec has achieved excellent results with its local community health centres. All these initiatives have solved different problems and demonstrate how flexible the legislation is.

The Minister of Health even recognized that private clinics offering medically necessary services can be an effective way to give such services, provided that the medically necessary services are fully covered by provincial or territorial health plans. What is totally unacceptable is, first, physicians extra-billing for services already covered by provincial or territorial health plans and, second, charging user fees for medically necessary services covered by provincial or territorial health plans.

In this era of fiscal restraint, Canadians want value for money. We pay for our health system collectively through our taxes. We all pay so that everyone can benefit according to need. There are altruistic human reasons and hard economic arguments for doing so. Whichever we support, the system works to our benefit. This government is committed to preserving the Canada Health Act because in spite of what its critics may say, it works.

For many of us, health care insurance is an essential part of the Canadian identity. We belong to a nation where all citizens are equal. Anyone in Canada can rely on reasonable access to health care services, not on the basis of wealth but according to need. Every Canadian can rest assured, now and in the future, that he or she will not be ruined financially by a serious illness. The Canadian health care system has no equal in the world. Treatment priorities are set in light of medically necessary services and not according to the patient's wealth.

The Canadian government takes very seriously its role as a defender of universal health care. The Minister of Health has expressed her strong opposition to facility fees, extra-billing and any other sign of a two-tier health care system. Canadians have entrusted their government with protecting their health care system. As the Prime Minister has repeatedly said, this government intends to show that it is worthy of this trust.

[Philippe Paré, Bloc, Louis-Hébert, QC]

Mr. Speaker, I think there is not one Canadian or Quebecer who questions the importance and value of the five principles set out in the Canada Health Act. However, the greatest threat to these principles, in my view, is the underfunding the Government of Canada has caused these past few years by phasing out financing in these areas.

Does the hon. member for Pierrefonds-Dollard recognize that this seriously threatens the principles he referred to and with which I totally agree? Reduced funding from the federal government may well place the provinces in a situation where,

while recognizing these principles as normal and necessary, they can no longer uphold them.

[Bernard Patry, Liberal, Pierrefonds—Dollard, QC]

Mr. Speaker, I thank the hon. member of the Bloc Quebecois for his question. I am very pleased to hear him say that he came to the same conclusion as I did, in that he agrees with the five principles I listed earlier.

There is a real problem with underfunding but it lies in the fact that social and health programs are provincially administered in Canada. Every province made its own choices. It is now up to these provinces to make new choices to cut their costs within the health system as we know it.

In certain parts of the country, provinces have allowed non- essential services to be provided to their citizens. I think that the ball is in the court of the provinces now.

[John Williams, Reform, St. Albert, AB]

Mr. Speaker, the hon. member may congratulate the Bloc for endorsing the five universal principles. However, I hope he will not congratulate the Reform Party because we do not endorse these five principles.

I would like to know what the hon. member is trying to do when he acknowledges there is a serious reduction in the amount of money being put into health care by this government. The provinces are cutting back as they try to balance their budgets. There is a significant reduction in the amount of cash going into the health care system, yet the Liberals with their heads in the sand seem to think it is business as usual. They seem to think that health care is going to continue on as it has been, uninterrupted without any problems while they cut back on the cash without having any opportunities or initiatives allowing the health care system to resolve its own problems through the market forces or whatever.

When will the Liberals get their heads out of the sand and recognize there is a real problem in health care that is caused by the lack of funding? When are they going to allow this additional funding either through taxpayers' dollars or by letting the marketplace put some money into it?

[Bernard Patry, Liberal, Pierrefonds—Dollard, QC]

I thank the hon. member of the Reform Party for his question.

I will answer the second part of his question first. There is no way that government will ever grant the Reform Party its wish for a two-tier health system, with one system for the rich and another for the poor. That is out of the question.

Extra billing and private clinics lead to a two tier system: one for the rich and another for the poor. The government in office in Ottawa will do no such thing because it is against its principles.

As for the first part of his question, I think that it is up to the provinces; they can and must cut their costs, which have become astronomical. There are certain things that must be looked at, costs, hospitals, provinces and even physicians, and I am one myself. Therefore, it is within the medical and social service community that the solution should be sought, and not in terms of the accessibility per se of the services.

[Hugh Hanrahan, Reform, Edmonton Strathcona, AB]

Mr. Speaker, it is my pleasure to address the issue of established programs funding in regard to health care.

The issue of established programs funding is of great concern to the constituents of my riding of Edmonton-Strathcona. While Alberta is battling its debt and deficit problem without increasing taxes, it is also doing it with less and less resources from the federal government. Since health care is Alberta's largest single area of government expenditure, I feel it is of the utmost importance to debate this issue.

In 1993-94 the federal government provided transfers of $40.5 billion to the provinces. The majority, approximately 71 per cent of these transfers, was for the established programs financing and equalization program. Out of this $40.5 billion, tax transfers were approximately $13 billion. It is the established programs funding, the tax transfers which I wish to spend most of my time discussing today. However, before we can discuss these transfers, it is important to look briefly at the equalization program.

Alberta has been deemed a have province. According to a recent study by a University of Calgary professor, it has paid in $139 billion more than it has received since Confederation.

[An hon. member]

We want it back.

[Hugh Hanrahan, Reform, Edmonton Strathcona, AB]

Albertans are gracious individuals and they have felt that being part of Canada has had its costs, but they also feel the benefits have outweighed these costs. I agree with that attitude, yet I also find that many Albertans are rethinking this attitude of generosity.

Another area that has become extremely contentious, particularly in Alberta and B.C. is the established programs funding. This funding is an arrangement between the federal government and the provinces relating to the funding of post-secondary education and health care. I will try to limit my comments solely to health care due to time limitations.

First, the Reform Party has no intention of dismantling medicare, nor do we want to create some form of a U.S. style

two-tier health care system. Instead, the Reform Party argues that our health care system is already gravely ill as its costs are going out of control in relation to the funding available.

Our intention is to ensure the long term viability of health care in this country. Health care is an issue which lies at the heart of most Canadians. It is Reform policy to ensure that no Canadian is denied adequate health care services for financial reasons, regardless of where they live in Canada.

Currently, provincial governments possess the legal and constitutional responsibility to provide health insurance and services. They do not however, possess the authority to take the administrative steps to control medical costs and/or raise additional revenue for health care services. Reformers believe that this arrangement puts both the federal and provincial governments at odds with each other, rather than allowing them to get on with the job of providing improved quality health care to all Canadians.

In fact, the Canadian Medical Association has argued that the country's health insurance system will be colliding with the economic reality in which it, the health care system, cannot be maintained in its present form. I believe this collision has already begun. This is apparent if we look at the federal budgets throughout the 1990s.

We have seen virtually a non-stop series of cuts and freezes in the federal government's transfers to the provinces. This has pushed the federal government into a corner. It realizes that it is risking losing control over national standards in health care should the cash transfers to any province cease entirely.

This problem is further troubled by the fact that federal provincial relations regarding transfers has been marked by decisions which have nothing to do with the search for balance or fairness in the use of our resources. I refer here to the national energy program and the recent gas tax that hit Alberta harder than any other province.

[Deborah Grey, Reform, Beaver River, AB]

And public utilities.

[Hugh Hanrahan, Reform, Edmonton Strathcona, AB]

Yes. It is for this reason that the Reform members of Parliament believe the only viable solution to safeguard our health care system from a fiscal crisis is to redefine the Canada Health Act. It should allow the provinces to find solutions that make the most sense for their region, through exercise of their constitutional jurisdiction over health care. The role of the federal government should be to provide financial support and equalization through the taxation and transfer system and to ensure that no Canadian is denied health care for financial reasons.

The Reform Party advocates amending the health care act to restore to the province the administrative jurisdiction the federal government has expropriated through the use of its spending powers. In other words, we will leave it in the hands of the provinces where it belongs.

What worked yesterday does not necessarily work today. What was taboo in the past is possibly accepted today. This applies to the federal transfer payment system which, after having its successes, is now coming up against its failures. Few people would dispute that to rectify the inefficient allocation of resources it is urgent that we put our public finances on a more solid footing to create an economic environment that will contribute more to efficiency and growth. However, the way to achieve this may not be compatible with certain political, social or provincial expectations.

As just stated, the federal government would seem to be feeling more and more trapped by its policy of imposing national standards and its desire to reconsider the refinancing of transfer payments.

We must continually remind ourselves it is the provinces and not the federal government that have the constitutional jurisdiction to operate the health care system. It is the provinces and not the federal government that provide the bulk of health care funding. It is the provinces and not the federal government that have the greatest expertise in health care delivery.

We on the Reform side of the House have to move ourselves away from the corner and into the forefront of health care policy issues. The way to do this is to focus the federal government's role on making no strings attached transfer payments to bring adequate health care within the financial reach of all provinces and citizens.

The provinces in consultation with patients, health care workers and taxpayers should be left to explore new options for greater health care efficiency without fear of being penalized by Ottawa.

We ultimately should be transferring additional tax points based on the notion that each province will clearly define what its core level of basic services will be. This list can ultimately and should differ from province to province. This would be our version of national standards to which the federal government could rate the provinces on their record against their core level of services.

Not only would we like to have a clearly defined level of basic core services but would also expect the provinces to shift more toward a community based development philosophy of delivering health care. This process and approach is to work with a community to address unmet needs and issues of concern to that specific community. It is based on the principle that the community affected by an issue is in the best position to articulate its needs and desires and to devise appropriate strategies to address these needs.

The core services and community based development approach, linked with the no strings attached tax point transfer, would ensure accessibility for everyone in a cost effective and efficient manner. This accessibility will ultimately be redefined to recognize that long waiting lists for essential services are a denial of access.

[Maria Minna, Liberal, Beaches—Woodbine, ON]

Mr. Speaker, I am having some difficulty understanding the logic of the hon. member for Edmonton-Strathcona. He is talking about transferring tax points with no strings attached. This is transferring more money to the provinces, giving them carte blanche and letting them decide what their core programs would be. Each province would decide what its core program would be and we would have different core programs from province to province.

He says he does not want to create a two tier program. I do not understand how the member can say that he would have an accessible health care system across the country where one province's accessibility would be defined in one way and another province differently. It is quite conceivable that in some provinces health care would not be accessible to people who are poor because they would have to pay certain types of remuneration or what have you.

I do not understand what the member is actually asking. Basically the current health care system structure has allowed the provinces to administer their health care systems as they wish as long as they are able to respect the five conditions. That is not so difficult. Those are not very difficult conditions to respect. His colleague earlier said they do not endorse the five principles. They are pretty broad.

I would like to know from the member exactly what kind of medicare system the Reform Party envisions. If it sees one different for every province with accessibility varying without any national principles, however broad, I have some difficulty with that. I would really like to understand where the provinces are now hampered in the administration of the health care system.

[The Acting Speaker (Mr. Kilger)]

While the hon. member for Edmonton-Strathcona is on his feet replying to the question from the hon. member for Beaches-Woodbine I wonder if he could refresh the memory of the Chair on whether he is splitting his time with a colleague.

[Hugh Hanrahan, Reform, Edmonton Strathcona, AB]

Mr. Speaker, we will be splitting our time.

I thank my colleague for her question. With respect to the distinction between provinces, she is aware that already happens. From the investigations I have made with various medical people they suggest there are health problems relatively unique to certain areas, to certain provinces, to certain communities. In those areas they should be able to direct as much of their resources as possible. We are trying to localize it to the people most affected.

With respect to the core area, that is something which we have to debate as a national government, a national society, and we have to come to some agreement as to what is universal from one end of the country to the other. However, there are certain aspects which do not require that.

In terms of accessibility, the essential core agreements must be available to all regardless of income. I believe I made that relatively clear in my speech.

[John Williams, Reform, St. Albert, AB]

Mr. Speaker, one of the five principles Liberals keeping talking about is the publicly funded one to the exclusion of all other input of cash into the health care system. I want to ask the hon. member for Edmonton-Strathcona if he feels their proposition of refusing any other means of funding health care will preserve our health care or should we allow other moneys into the program?

[Hugh Hanrahan, Reform, Edmonton Strathcona, AB]

Mr. Speaker, if we do not allow other moneys into the program, if we continue the decline in financing for medicare which has been occurring over the last number of years, combined with increase in the interest on the debt, we will find there will be a no tier system, not a two-tier system. There will be no medicare for anyone.

This is an attempt to save medicare.

[Bob Speller, Liberal, Haldimand—Norfolk, ON]

Do you want a three tier system?

[Hugh Hanrahan, Reform, Edmonton Strathcona, AB]

I said very clearly in my speech that is exactly what we do not want. We want to save the basic elements of medicare for all Canadians regardless of income.

[Deborah Grey, Reform, Beaver River, AB]

Mr. Speaker, on this business of a two-tier system, do we want it or do we not want it, we have had it for years. Let me draw to the member's attention that we have a two-tier health care system right now.

If my friends would like to get out their wallets or their purses or whatever, I would refer them to their benefits card from the public service health care plan. Mine says: "D.C. Grey, hospital level three". As soon as we see other levels we ask whether this is a two-tier health care system or a one tier system. Members opposite shun that and talk about the fact that we could never have a two-tier health care system. My card says level three, so how many tiers are we looking at here?

Let me also draw to their attention that MPs pay exactly zero; zero comes off their paycheques every month.

Anyone in the gallery who works for the public service or anyone who works in our offices, anyone who is a public servant, has the option to have a level three health care card. My

staff members have those. They pay if they are single $5.32 a month; if they are a family they pay $10.35 a month. I got that today from our pay and benefits clerk in the comptroller's office.

If we are to talk about two tier health and be so sanctimonious about it, that we in the Reform Party will only have an American system in two tier health, this is nonsense. We cannot beat around the bush because that is fact. We pay zero for this level of hospitalization. Public servants, people who work for us in our offices, pay $5.32 or $10.35 a month. That is two tier or spending differently. MPs are off the hook again; zero comes off our paycheques for that. We have some serious problems in the country and that is one tiny example.

We are in favour and believe every Canadian should have access to health care regardless of their ability to pay. That is a fact. That is important across the country. It comes down to how we will pay for that. The country is $550 billion in the hole and yet the health minister this morning said it is just going along fine and we have lots of money.

Deficit spending in the late sixties and early seventies has dug us into a hole so deep that if we do not get this thing under control even the size of the Chamber would not hold the cash we owe. It is rising at a rate of $1,500 per second.

For people on the government benches to say we are dreaming on this side of the House and everything is as safe as could be forever, that is not true.

My friends across the way know it. We cannot be eating up interest rate payments at the rate we are paying and expect everything and the status quo to go along as it has.

There are discrepancies in the system right now. The system needs to be fixed. There are many tiers, many levels of health care. Let us admit it rather than having a shade pulled over our eyes and trying to go out to Alberta and scare the daylights out of us and my health care minister. Do not try to frighten anybody. Do not accuse Reformers or the Bloc of fearmongering.

We are dealing with the facts. We have serious economic problems. We do have a two tier health system. My friend from Winnipeg this morning, a doctor, said he was all in favour of the Liberal plan of health care. He was specifically asked whether he had ever in his medical practice referred one of his patients to the Mayo Clinic. I suspect he did. I suspect there were many times in his medical profession because I think he was an excellent doctor who would tell someone they needed to get to the Mayo Clinic fast. Winnipeg is plenty close to the Mayo. I bet he referred lots of patients there.

I bet the doctor from Vancouver Centre who lives close to the American border, in someone's best interest if they could afford to pay, would send them down to the Mayo Clinic, California, Seattle or wherever for health care if they could afford it. This is happening all the time.

To say we are just fearmongering in the Reform Party, forget that. Let us get on with solving the problem.

They also talked about our position in the campaign. That was $150 billion ago. The national debt is now at $550 billion, $150 billion more than when a lot of greenhorns walked into this place not even a year and a half ago. The debt and the interest on it are chewing so quickly that if we do not get this problem under control it will destroy the national medicare program more than anything else.

Is there a mix of health care plans? I was really surprised as a westerner when I first came down here to discover that even though I in my teaching career had been paying for my Alberta health care forever people in Ontario do not even pay for their premiums. That sounded pretty strange to me. They do not in Manitoba either.

[John Harvard, Liberal, Winnipeg—St. James, MB]

Why should we?

[Deborah Grey, Reform, Beaver River, AB]

Why should we, he says. I guess if everything is self-financing and self-funding and the country is in great shape, sure, let us offer freebies.

We continue to pay for health care premiums and I do not think people mind that because they know the service they get is absolutely terrific. Some provinces charge health care premiums, others do not. That is the way it is.

Some people have private insurance to supplement their basic coverage. That is the way it is. People who can afford to pay are perfectly entitled to do so. In my province, some can afford to get eye laser surgery at the Gimble clinic either in Calgary or the new one in Edmonton. Those people say: "I want to pay for it. I will step out of the queue of those waiting for laser surgery, perhaps at the University of Alberta Hospital, and I will get it done at the Gimble clinic. I will pay my $1,200 and I will free up a spot in a public institution for somebody who is waiting in the line". That is not reprehensible. That is the way it has been for a long time.

Somebody says: "Yes, it is reprehensible". What about people who live on welfare? Do we who have jobs say: "Isn't it dreadful about all of those on welfare". No, we are grateful to have a job and we will pay our taxes. We will make sure those who are needy in our society are able to collect welfare. Surely that is not reprehensible.

Would my friend over here quit her job right now as an MP and not pay taxes any more because she does not think her tax money should support welfare for the people who really need it?

Of course not. Well, she is thinking on that. Those of us who pay are blessed. We are able to pay our taxes and we want them to go to the more needy in our society. Why should we not do it with health care? It makes perfect sense to me.

The hon. member should not hog the line-up. She has her place in the queue. If she is in there and says that she gets health care because, or maybe she is demanding child care, who knows? She is making $60,000 a year. I would say let her pay her own babysitters. This is nothing different. If you are able to pay, pay and step aside for someone who may be a little more needy. Perhaps not so sanctimonious but maybe a little more needy.

We are under no illusion here. We have some serious problems with health care. Federal cash transfers in support of health care are projected to go down to zero in the next 10 to 15 years. This is from a government, a Liberal government. Medicare is having its 30th birthday. It is wheezing and gasping its last breath on its 30th birthday.

There are real problems. Funding? Sorry, the well has dried up. Under successive Liberal governments year after year we are deficit spent and we are really sorry but the well has run dry. The Liberals cannot go to the Canadian public and say: "Sorry that is just the way it is" yet pretend, give speeches, go on CBC and CTV News saying: "We have all the money we need for it". The minister said that today. I hope they show a clip of that on the national news tonight. There are a lot of people, a lot of taxpayers who know that is absolute fantasy.

It would make sense to prepare for that day. We know we have problems. Let us prepare for that day. Let us be ready for it rather than just saying: "Do not touch it, do not do anything to it". We are in bad shape financially and we need to make sure we move ahead and solve the problems instead of just complaining about them.

In my province of Alberta there have been huge cuts. I want to let the hon. members know that in 1970, 25 years ago, the whole budget for Alberta was $1 billion for everything, not just health care. In 1982, 12 years later, the entire budget was $12 billion. We had some boom years in our province. With the oil boom we went from a $1 billion budget to $12 billion in 12 years. That is a lot of money. Imagine what happened. Hospitals sprang up all over. We were spending two to three times per capita on each Albertan as many other provinces were doing. Many of these cutbacks may just be bringing us back to some of those levels.

Recently I underwent major surgery at the University of Alberta Hospital in Edmonton. My experience there-I can only talk for myself-is that for major surgery, for a hysterectomy, I waited my time in line. I did not want to go to the National Defence Centre and jump the queue. I said: "I will go. I pay my health care. I pay premiums in Alberta. So I will take my turn and just go in with the regular run of the mill people". I was asked: "Do you want a room of your own?. It is $40 a night". I thought: "That is cheaper than the Relax Inn so sure I will book in for it". Little did I know because I have never been sick and am grateful for that, my health care card, level three for which I pay the goose egg, absolutely nothing every month, covered my room. I was grateful for that.

The people in that hospital were professional. They were kind, looked after me and treated me really well. I am standing here, two months later, fully recovered and recuperated. Perhaps I am an example that the health system works. However, let us make sure that we do not let it get any sicker or in any worse shape than it is already.

Health care is worth it in this country. Regardless of the fact that members say there are no tiers in it, let us shed some tears for the system and make sure we make it right.

[Maria Minna, Liberal, Beaches—Woodbine, ON]

Mr. Speaker, I would first like to correct the first statement the hon. member made with respect to the two-tier system for MPs versus our staff.

The two tiers do not exist. Medically necessary physician or hospital services are the same. There is no difference. One gets the same hospital and the same doctor. The only difference is there is a TV in the room which one can decline. The hon. member chose the TV but she could have said no. The medical care is not different. There is no difference between the hospital one goes to, the doctor one gets, the services one receives or the nurses who serve us.

I heard today from the hon. member and other colleagues about core medical services and that core services should be identified. I am trying to understand what the difference is between core services and medically necessary services as defined in the Canada Health Act. What is the real difference between core and medically necessary? I think they are one and the same and that we are playing with words here.

I would like the Reform members to define for me what core services are and how it differs from what we now have in the act.

I am very proud to pay my taxes. I do not consider welfare to be charity. I consider welfare to be the right of needy people who have fallen on hard times.

[Deborah Grey, Reform, Beaver River, AB]

Needy people.

[Maria Minna, Liberal, Beaches—Woodbine, ON]

Absolutely. I am quite proud to pay my taxes to help those people. I do not consider it charity which is why I am not for workfare or any such thing. These people have a right to be assisted by the system and the government. They have paid taxes before and they have earned the assistance.

With respect to the Gimble clinic, laser surgery and stepping out of line, I do not want that system. Before we know it we will have a system where the people who can afford it will always be stepping out of line. The best specialists can charge more money because profit as a motive will always be working in the best clinics. Before we know it we will end up with a two-tier system

no matter how we look at it. I have seen it happen in other jurisdictions and it will happen here. It is not necessary.

The publicly administered health care system is the most cost effective system in the world. It saves money because the motive is not profit, it is to deliver the best possible system to the citizens of the province.

Those are my comments and some of my questions. I would really like to understand what core services are to the Reform Party as I have not quite understood that yet.

[Deborah Grey, Reform, Beaver River, AB]

Mr. Speaker, I appreciate the member's remarks. What part of this two-tier system does the member not understand? It just baffles me. I am usually not at a loss for words and my friend knows that. Anybody who has ever known me, and my family certainly knows, I am usually not stumped for something to say, but I can hardly believe it. I can hardly believe that someone would say we get the same hospital care and there is no difference in it.

Somebody who says that the Gimble Eye Clinic is only for people who can afford it should know they have been doing this for years. People go to abortion clinics. The minister talks regularly and incessantly about facility fees and that she will not allow them in Alberta. What about the people going to freestanding abortion clinics right across the country? Is that a facility fee? Sure it is. Somebody talked earlier today about Quebec psychoanalysts being de-insured now. This goes on and on.

Core services and medically necessary services are things that are absolutely essential. These could be life saving devices or a hysterectomy, if there is cancer, all those types of things. If someone wants to get a nose job, if it is necessary, is affecting one's breathing, let us let the medical profession determine this. However, if one just wants to go in and get plastic surgery, a nose job, a face lift or whatever other lift one might want, those are the kinds of things that the medical community is quite capable of deciding which is core and which is not core.

Those procedures which are life saving are core. But it is not a government's responsibility to sit in the House of Commons and make those decisions. Let the medical profession do it.

There are very capable doctors on the government side as well as over here. Let them decide and then we will support that.